United KingdomAgenda for Change (AfC)
Definition
Agenda for Change (AfC) is the national pay and conditions system for NHS staff in the UK other than doctors, dentists and very senior managers, which places every job in one of nine pay bands using the NHS Job Evaluation Scheme.
Also called: AfC, NHS pay bands, NHS terms and conditions of service, NHS TCS handbook, Agenda for Change pay scales, NHS bands 1 to 9
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What is Agenda for Change?
Agenda for Change is the system that sets pay, hours, leave and other terms for most NHS staff. Its rules are in the NHS Terms and Conditions of Service Handbook, which NHS Employers says applies in full to non-medical staff directly employed by NHS organisations, except very senior managers. Changes are negotiated through the NHS Staff Council.
AfC covers nurses, midwives, allied health professionals such as physiotherapists and radiographers, pharmacists, healthcare scientists, healthcare assistants and administrative staff. Doctors and dentists have separate national contracts; see SAS doctor and specialty training.
How the bands work
Each job is matched to a band using the NHS Job Evaluation Scheme and national job profiles. Band 1 is closed to new entrants, so the bands in use run from Band 2 to Band 9, with Band 8 split into 8a to 8d. Within a band there are pay points; staff move up after set periods, provided the expected performance has been achieved. The 2026/27 pay scales for England, effective from 1 April 2026, are:
- Band 2: £25,272
- Band 3: £25,760 to £27,476
- Band 4: £28,392 to £31,157
- Band 5: £32,073 to £39,043
- Band 6: £39,959 to £48,117
- Band 7: £49,387 to £56,515
- Band 8a: £57,528 to £64,750
- Band 8b: £66,582 to £77,368
- Band 8c: £79,504 to £91,609
- Band 8d: £94,356 to £108,814
- Band 9: £112,782 to £129,783
Newly registered nurses, radiographers, physiotherapists and many other clinicians usually start at Band 5. Scotland, Wales and Northern Ireland publish their own AfC scales.
Hours, leave and London weighting
- Hours: the handbook uses 37.5 hours a week as the standard for full-time staff.
- Annual leave: 27 days on appointment, 29 days after five years' service and 33 days after ten years, plus 8 general public holidays.
- High cost area supplements: in 2026/27, 20 percent of basic pay in inner London (minimum £5,794, maximum £8,746), 15 percent in outer London and 5 percent in the fringe.
What it means for international recruits
If you join an NHS employer in England on AfC terms, your band is set by the job you are appointed to, not by your grade or title abroad. An experienced nurse from overseas will usually still start in a Band 5 post after registration, then apply for Band 6 roles as they gain UK experience. Your salary must also meet the visa rules; see our Health and Care Worker visa guide and nurses in the UK guide.
How AfC pay changes each year
The government decides the annual pay award after a recommendation from the independent NHS Pay Review Body. For 2026/27, NHS Employers reported on 12 February 2026 that staff on AfC terms in England would receive a 3.3 percent consolidated uplift, paid from April 2026. The new figures then appear in the published pay scales and the NHS Employers pay circulars.
Common problems
- Comparing gross AfC pay with tax-free Gulf salaries without allowing for tax, pension and housing.
- Assuming pay before registration is Band 5. Employers set the band for the period before you are registered.
Questions
No. Agenda for Change excludes doctors, dentists and very senior managers. Doctors are paid under separate national contracts such as the resident doctors, SAS and consultant contracts.
Usually Band 5. In England, Band 5 pay for 2026/27 runs from £32,073 to £39,043, effective from 1 April 2026.
Moving to a higher band means getting a job that is evaluated at that band. Within a band, you move up pay points after set periods, provided the expected performance has been achieved.
27 days on appointment, 29 days after five years' service and 33 days after ten years, plus 8 general public holidays, for full-time staff.
Yes. High cost area supplements add 20 percent of basic pay in inner London, 15 percent in outer London and 5 percent in the fringe, each with a minimum and maximum.
NHS Employers reported on 12 February 2026 that AfC staff in England would receive a 3.3 percent consolidated uplift, effective from April 2026, following the NHS Pay Review Body's recommendation.